The Needlestick Safety and Prevention Act (H.R. 5178) mandated that the
1991 Bloodborne Pathogens Standard (29 CFR 1910.1030) be revised to
strengthen the requirements related to the use of safety-engineered
sharp devices. OSHA published the revised standard in the Federal
Register on January 18, 2001; it became effective April 18, 2001.
Below we review the major provisions of the law and discuss some
frequently asked questions about it.

Provisions of the new
law:

n Requires health care employers to document in their
exposure control plan that they have evaluated and implemented
safety-engineered sharp devices and needleless systems in
order to reduce employees' occupational exposure to HIV, hepatitis C
and other bloodborne diseases; and

n Requires that exposure control plans be reviewed
and updated at least annually to reflect changes in sharps safety
technology.

n Requires each health care facility to maintain a sharps
injury logwith detailed information on
percutaneous injuries (including type and brand of device involved in
exposure incident, department where exposure occurred and an
explanation of how it occurred).

n Requires employers to solicit input from non-managerial
(e.g., frontline) health care workers when identifying,
evaluating and selecting safety-engineered sharp devices, and to
document this process in the exposure control plan.

n Expands the definition of "engineering controls"
to include devices with engineered sharps injury protection.

Frequently Asked Questions:

nWhich health care facilities are covered by the new
law?

The new federal law and the revised Bloodborne Pathogens Standard
apply to any facility under federal OSHA where employees may
be exposed to blood or other potentially infectious material, such as
hospitals, long-term care facilities, clinical laboratories,
physicians' offices and dentists. The law and revised standard do
not cover public (state and municipal) facilities in federal
OSHA states. (Note, however, that of the 27 states that are under
federal OSHA, nine—Georgia, Maine, Massachusetts, Missouri, New
Hampshire, Ohio, Rhode Island, Texas and West Virginia—have passed
needle safety laws covering public health care settings.)

nWhat are the requirements for facilities in states with
their own OSHA plans?

States with state OSHA plans (there are 23) must have regulations
that are "at least as effective" (that is, at least as protective) as
those of federal OSHA. These states must have a revised bloodborne
pathogens standard that is equivalent to federal OSHA's in place by
October 18, 2001. In the interim, state plans will continue to enforce
their current requirements. Some states with state OSHA plans, such as
California, have already revised their bloodborne pathogens standard to
require the use of safer devices.

nWhat effect does the new law have on OSHA’s November
1999 compliance directive (CPL 202.44D) for the Bloodborne Pathogens
Standard?

In drafting the federal Needlestick Safety and Prevention Act,
legislators relied on the language and overall content of the
compliance directive regarding requirements for the use of safety
devices. H.R. 5178 provides legislative authority for OSHA’s current
enforcement emphasis on the use of safety devices as a primary
engineering control to prevent occupational exposures to bloodborne
pathogens. In addition to emphasizing the use of safety devices, OSHA’s
compliance directive also provides guidance on a number of other
issues, such as updated requirements for post-exposure follow-up that
include hepatitis C virus. (The revised compliance directive and
additional compliance information and training resources are available
on OSHA’s web site: www.osha-slc.gov/SLTC/needlestick/compliance.html.)

nDoes OSHA require safety devices now?

Use of sharps with engineered sharps injury protection is required
now. OSHA has the authority under the
Bloodborne Pathogens Standard to require the use of engineering
controls, such as safety devices, to reduce risk to workers. OSHA
clarified its position in November 1999 with the revised compliance
directive, and outlined the requirements and enforcement procedures for
implementation of sharps injury prevention devices. Since November
1999, OSHA has cited health care facilities for failure to use safety
devices. In determining a facility’s compliance with the standard, OSHA
has considered, among other factors, evidence of adoption of safety
devices and whether the exposure control plan includes on-going
selection, evaluation, and implementation of such devices, with a
timeline for implementation.

The federal Needlestick Safety and Prevention Act does not change
the current enforcement activities of OSHA, but rather gives a
legislativemandate for OSHA’s requirement
that health care employers provide their employees with
safety-engineered sharp devices.

n Now that the Bloodborne Pathogens Standard has been
revised to emphasize the use of safer devices, as mandated by H.R.
5178, will OSHA be stepping up its enforcement of the
standard?

OSHA has already started conducting more inspections of
health care facilities. During inspections, compliance with all
occupational safety and health requirements is reviewed, including the
Bloodborne Pathogens Standard. The increase in inspections is part of a
recent initiative that included a letter sent to 2,600 health care
facilities that had the highest average illness and injury rates,
announcing that OSHA would be conducting targeted inspections. The
major source for OSHA inspections of health care facilities, however,
will still be employee complaints. Thus it will be important to adhere
to the requirement in H.R. 5178 that frontline workers’ input be
included in the development and implementation of a sharps injury
program, in order to assure that their needs and safety concerns are
being met.

nWhat should our facility do now?

Collect exposure data, using a system such as
EPINet. This data is essential to understanding
where exposures are occurring in a facility, and what interventions,
including safer devices, are necessary to prevent them. If your
facility already has a system in place for tracking sharp-object
injuries and blood and body fluid exposures, make sure the forms
solicit information on the following: type and brand of device causing
the injury, department where the exposure occurred, and an explanation
of how the incident occurred. The new federal law requires that this
information be collected. (The latest Access version of EPINet includes
all this information on its data collection forms; for a copy, call
Ginger Parker at the International Health Care Worker Safety Center at
(804) 982-0702, or e-mail her at gingerparker@virginia.edu.)

Establish a sharps injury task
force. Each facility should have a
multidisciplinary task force and assigned leader to coordinate the
sharps injury prevention program. The task force should include both
managerial and non-managerial (frontline) workers to assist with the
development or revision of a plan for selection, evaluation and
implementation of safety devices. Consider safety devices as one
component of an overall sharps injury prevention program that includes
management commitment to worker safety, education and training on the
use of safety devices, strategies to encourage compliance with the use
of safety devices, and ongoing evaluation of the effectiveness of
safety devices in reducing the risk of injury from contaminated
sharps.

Revise exposure control plan.
The exposure control plan should be revised to include the plan and
timetable for evaluating and implementing safety-engineered devices in
all device categories with potential for bloodborne pathogen exposure.
The involvement of frontline workers in the device selection process
should be documented in the plan.

Select and evaluate devices. The
new law does not recommend specific devices, but requires employers to
conduct their own evaluations of available safety devices. At present,
there are relatively few studies documenting the efficacy of specific
safety devices. Therefore, hospitals must select devices to evaluate
based on a consideration of their own needs and requirements. If your
facility has group purchasing contracts, start by reviewing the safety
devices that are currently under contract. Note, however, that health
care facilities must evaluate any safety device they believe is
appropriate for their specific needs, regardless of whether it is
covered by a group purchasing contract.

Implement safety devices. When
evaluation is complete, devices should be implemented promptly after
appropriate education and training on the use of the device.